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田 楚, 陈 翔, 朱 桓, 秦 晟, 石 柳, 芮 云. [Application and prospect of machine learning in orthopaedic trauma]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1562-1568. [PMID: 38130202 PMCID: PMC10739668 DOI: 10.7507/1002-1892.202308064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 12/23/2023]
Abstract
Objective To review the current applications of machine learning in orthopaedic trauma and anticipate its future role in clinical practice. Methods A comprehensive literature review was conducted to assess the status of machine learning algorithms in orthopaedic trauma research, both nationally and internationally. Results The rapid advancement of computer data processing and the growing convergence of medicine and industry have led to the widespread utilization of artificial intelligence in healthcare. Currently, machine learning plays a significant role in orthopaedic trauma, demonstrating high performance and accuracy in various areas including fracture image recognition, diagnosis stratification, clinical decision-making, evaluation, perioperative considerations, and prognostic risk prediction. Nevertheless, challenges persist in the development and clinical implementation of machine learning. These include limited database samples, model interpretation difficulties, and universality and individualisation variations. Conclusion The expansion of clinical sample sizes and enhancements in algorithm performance hold significant promise for the extensive application of machine learning in supporting orthopaedic trauma diagnosis, guiding decision-making, devising individualized medical strategies, and optimizing the allocation of clinical resources.
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Affiliation(s)
- 楚伟 田
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 翔溆 陈
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 桓毅 朱
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 晟博 秦
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 柳 石
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 云峰 芮
- 东南大学附属中大医院骨科(南京 210009)Department of Orthopedics, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学附属中大医院创伤救治中心(南京 210009)Trauma Center, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
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Le TD, Lin SC, Huang MC, Fan SY, Kao CY. Factors impacting the demonstration of relational autonomy in medical decision-making: A meta-synthesis. Nurs Ethics 2023:9697330231200570. [PMID: 37818823 DOI: 10.1177/09697330231200570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Relational autonomy is an alternative concept of autonomy in which an individual is recognized as embedded into society and influenced by relational factors. Social context, including social location, political structure, and social forces, significantly influence an agent to develop and exercise autonomy skills. The relational approach has been applied in clinical practice to identify relational factors impacting patient autonomy and decision-making, yet there is a knowledge gap in how these factors influence the demonstration of relational autonomy in the context of medical decisions of adults. OBJECTIVE The present study targeted the existing knowledge of what and how relational factors impact individuals making medical decisions using the theoretical framework of relational autonomy. METHODS A meta-synthesis study was utilized. Four electronic databases, including Embase, OVID Medline, CINAHL, and PubMed, were searched, along with gray literature and reference lists, to identify relevant studies. RESULTS 23 studies reporting 21 qualitative and two mixed-method studies were reviewed. Four themes emerged from the qualitative findings: (1) supportive relationships facilitate an individual's relational autonomy; (2) obtaining comprehensive information from broader sources helps individuals exercise relational autonomy; (3) undue family pressure impedes the exercising of patient relational autonomy; and (4) healthcare providers' dominant voice hampers the demonstration of relational autonomy. CONCLUSIONS Applying relational autonomy to assist adults in making well-considered decisions is essential. The meta-synthesis suggests establishing a supportive relationship between individuals, healthcare providers, and family. A supportive relationship will allow healthcare providers to make judgments in line with an individual's values and wishes with the aim of promoting relational autonomy. Advance care planning was proposed as the effective solution to obtain a consensus between individuals and their families while respecting an individual's values and preferences. Furthermore, it is considered crucial for healthcare providers to appreciate an individual's values and incorporate their preferences into recommendations.
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Affiliation(s)
| | | | - Mei-Chih Huang
- National Cheng Kung University, Taiwan
- National Tainan Junior College of Nursing, Taiwan
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3
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Payot C, Fehlmann CA, Suppan L, Niquille M, Lardi C, Sarasin FP, Larribau R. Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest. Int J Environ Res Public Health 2021; 18:ijerph18168323. [PMID: 34444071 PMCID: PMC8391446 DOI: 10.3390/ijerph18168323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR.
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Affiliation(s)
- Charles Payot
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christophe A. Fehlmann
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada
- Emergency Medicine, Research Group, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Christelle Lardi
- University Center of Legal Medicine (CURML), Geneva University Hospitals, 1211 Geneva, Switzerland;
| | - François P. Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland; (C.P.); (C.A.F.); (L.S.); (M.N.); (F.P.S.)
- Correspondence: ; Tel.: +41-79-553-9400
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Ma Q, Sun D, Cui F, Zhai Y, Zhao J, He X, Shi J, Gao J, Li M, Zhang W. Impact of the Internet on Medical Decisions of Chinese Adults: Longitudinal Data Analysis. J Med Internet Res 2020; 22:e18481. [PMID: 32880581 PMCID: PMC7499166 DOI: 10.2196/18481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions. OBJECTIVE The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose. METHODS With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015. RESULTS Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions. CONCLUSIONS Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.
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Affiliation(s)
- Qianqian Ma
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Yunkai Zhai
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
- School of Management Engineering, Zhengzhou University, Zhengzhou, Henan, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Jinghong Gao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Mingyuan Li
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
| | - Wenjie Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- National Telemedicine Center of China, Zhengzhou, Henan, China
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5
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Brick C, McDowell M, Freeman ALJ. Risk communication in tables versus text: a registered report randomized trial on 'fact boxes'. R Soc Open Sci 2020; 7:190876. [PMID: 32269779 PMCID: PMC7137953 DOI: 10.1098/rsos.190876] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/27/2020] [Indexed: 06/09/2023]
Abstract
OBJECTIVES identifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy and medical decision-making. This study tested whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context. DESIGN pre-registered, longitudinal experiment: between-subjects factorial 2 (message format) × 2 topic (therapeutic or preventative intervention) on comprehension and later recall (CONSORT-SPI 2018). SETTING longitudinal online survey experiment. PARTICIPANTS 2305 census-matched UK residents recruited through the survey panel firm YouGov. PRIMARY OUTCOME MEASURE comprehension of harms and benefits and knowledge recall after six weeks. RESULTS fact boxes-simple tabular messages-led to more comprehension (d = 0.39) and slightly more knowledge recall after six weeks (d = 0.12) compared to the same information in text. These patterns of results were consistent between the two medical topics and across all levels of objective numeracy and education. Fact boxes were rated as more engaging than text, and there were no differences between formats in treatment decisions, feeling informed or trust. CONCLUSIONS the brief table format of the fact box improved the comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision-making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts.
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Affiliation(s)
- Cameron Brick
- Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, UK
- Department of Psychology, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Michelle McDowell
- Harding Center for Risk Literacy, University of Potsdam, 14469 Potsdam, Germany
- Max Planck Institute for Human Development, 14195 Berlin, Germany
| | - Alexandra L. J. Freeman
- Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, UK
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Maroudy D. [Decision-making in the context of organ donation]. Soins 2019; 64:55-59. [PMID: 30879635 DOI: 10.1016/j.soin.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The medical decision regarding organ removal is an act which the law tends to reduce and subject to a simple legal process. The complexity and extreme sensitivity of the human principles, values and sentiments at play do not warrant this simplification. The decision-making process involves several parties and respects the temporality of the families.
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Affiliation(s)
- Daniel Maroudy
- c/o Soins, Elsevier Masson SAS, 65, rue Camille-Desmoulins, 92442 Issy-les-Moulineaux, France.
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Colomé À, Rodríguez-Ferreiro J, Tubau E. Too Worried to Judge: On the Role of Perceived Severity in Medical Decision-Making. Front Psychol 2018; 9:1906. [PMID: 30356743 PMCID: PMC6189396 DOI: 10.3389/fpsyg.2018.01906] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022] Open
Abstract
Ideally, decisions regarding one’s health should be made after assessing the objective probabilities of relevant outcomes. Nevertheless, previous beliefs and emotional reactions also have a role in decision-making. Furthermore, the comprehension of probabilities is commonly affected by the presentation format, and by numeracy. This study aimed to assess the extent to which the influence of these factors might vary between different medical conditions. A sample of university students were presented with two health scenarios containing statistical information on the prevalence of breast cancer and hypertension either through icon arrays (N = 71) or natural frequencies (N = 72). They also received information regarding a preventive measure (mammogram/low-sodium diet) and the likelihood of a positive mammogram or a rich-sodium diet either when suffering or not suffering from the disease. Before seeing the data, participants rated the severity of the disease and the inconvenience of the preventive measure. After reading the health scenario, participants had to rate its difficulty, and how worrisome it was. They had also to rate the prior probability of suffering from this medical condition, and the posterior probability of it, provided a positive mammogram or a rich-sodium diet. Finally, they rated the extent to which they would recommend the preventive measures. All the rates used the same 1 (little)-8 (a great deal) scale. Participants’ numeracy was also assessed. The scenarios differed significantly in perceived severity and worry, with the cancer scenario obtaining higher scores. Importantly, regression analyses showed that the recommendations in the two health scenarios depended on different variables. A model taking into consideration severity and worry rates best explained decisions in the cancer scenario; in contrast, in the hypertension scenario the model that best explained the recommendations comprised both the posterior probability estimate and the severity rate. Neither numeracy nor presentation format affected recommendation but both affected difficulty, worrying and probability rates. We conclude that previous perceptions of the severity of a health condition modulate the use of probabilistic information for decision-making. The roles of presentation format and numeracy in enabling patients to understand statistical information are also discussed.
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Affiliation(s)
- Àngels Colomé
- Section of Cognitive Processes, Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Ferreiro
- Section of Cognitive Processes, Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Elisabet Tubau
- Section of Cognitive Processes, Department of Cognition, Development and Educational Psychology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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8
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Dupont M, Volpe A. [Not Available]. Soins Pediatr Pueric 2017; 38:16-18. [PMID: 28705561 DOI: 10.1016/j.spp.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
When it comes to medical care, the move from minor to adult status is problematic, between the age of puberty and the age of majority, which only allows decisions to be taken independently. Medical law has evolved over the last few years, propelled by the promotion of child rights. It gives more space for adolescents to decide about their own health.
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Affiliation(s)
- Marc Dupont
- Direction des affaires juridiques, Assistance publique-Hôpitaux de Paris, 3 avenue Victoria, 75004 Paris, France.
| | - Audrey Volpe
- Direction des affaires juridiques, Assistance publique-Hôpitaux de Paris, 3 avenue Victoria, 75004 Paris, France
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9
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Song MK, Ward SE, Fine JP, Hanson LC, Lin FC, Hladik GA, Hamilton JB, Bridgman JC. Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates. Am J Kidney Dis 2015; 66:813-22. [PMID: 26141307 DOI: 10.1053/j.ajkd.2015.05.018] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/21/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Few trials have examined long-term outcomes of advance care planning (ACP) interventions. We examined the efficacy of an ACP intervention on preparation for end-of-life decision making for dialysis patients and surrogates and for surrogates' bereavement outcomes. STUDY DESIGN A randomized trial compared an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) to usual care alone, with blinded outcome assessments. SETTING & PARTICIPANTS 420 participants (210 dyads of prevalent dialysis patients and their surrogates) from 20 dialysis centers. INTERVENTION Every dyad received usual care. Those randomly assigned to SPIRIT had an in-depth ACP discussion at the center and a follow-up session at home 2 weeks later. OUTCOMES & MEASUREMENTS PRIMARY OUTCOMES preparation for end-of-life decision making, assessed for 12 months, included dyad congruence on goals of care at end of life, patient decisional conflict, surrogate decision-making confidence, and a composite of congruence and surrogate decision-making confidence. SECONDARY OUTCOMES bereavement outcomes, assessed for 6 months, included anxiety, depression, and posttraumatic distress symptoms completed by surrogates after patient death. RESULTS PRIMARY OUTCOMES adjusting for time and baseline values, dyad congruence (OR, 1.89; 95% CI, 1.1-3.3), surrogate decision-making confidence (β=0.13; 95% CI, 0.01-0.24), and the composite (OR, 1.82; 95% CI, 1.0-3.2) were better in SPIRIT than controls, but patient decisional conflict did not differ between groups (β=-0.01; 95% CI, -0.12 to 0.10). SECONDARY OUTCOMES 45 patients died during the study. Surrogates in SPIRIT had less anxiety (β=-1.13; 95% CI, -2.23 to -0.03), depression (β=-2.54; 95% CI, -4.34 to -0.74), and posttraumatic distress (β=-5.75; 95% CI, -10.9 to -0.64) than controls. LIMITATIONS Study was conducted in a single US region. CONCLUSIONS SPIRIT was associated with improvements in dyad preparation for end-of-life decision making and surrogate bereavement outcomes.
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Affiliation(s)
- Mi-Kyung Song
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Sandra E Ward
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | - Jason P Fine
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura C Hanson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Feng-Chang Lin
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Jessica C Bridgman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
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10
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Abstract
There are several advantages to evaluating a problem using influence diagram operations. The analyst can use a representation that is natural to the decision maker, since the algorithm executes all of the inference and analysis automatically. The influence diagram solution procedure can also result in significant gains in efficiency. Conditional independence is clearly exhibited in the diagram, so the size of intermediate calculations can be reduced, resulting in considerable reductions in both processing time and memory requirements. However, when imprecise knowledge from data sets is involved in the systems, how to reason from approximate information becomes a main issue in evaluating influence diagrams effectively. This study develops an alternative knowledge model, rough-set influence diagrams (RSID), which combine rough-set decision rules and graphical structures of influence diagrams in medical settings. The proposed RSID provides a comprehensive schema for knowledge representation and decision support.
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Affiliation(s)
- Chia-Hui Huang
- Department of Business Administration, National Taipei University of Business , Taipei City, Taiwan
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11
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Jekunen A. Clinicians' expectations for gene-driven cancer therapy. Clin Med Insights Oncol 2014; 8:159-64. [PMID: 25574148 PMCID: PMC4271717 DOI: 10.4137/cmo.s20737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/19/2014] [Accepted: 11/21/2014] [Indexed: 12/15/2022]
Abstract
A new era of medicine is rapidly approaching, which will change not only pathological diagnosis but also medical decision-making. This paper raises the question of how well prepared doctors are to address the new issues that will soon confront them. The human genome has been completely sequenced and general understanding about cancer biology has increased enormously with understanding that unregulated gene function and complicated changes in signal pathways are related to uncontrolled cell growth. Thus, gene-driven therapy involving alterations to genes are recognized to present new therapy options. This advance will necessitate major changes to the decision-making aspect of physicians. This article focuses on defining the pertinent changes and addressing what they mean for practicing physicians.
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Affiliation(s)
- Antti Jekunen
- Vaasa Oncology Clinic, Turku University, Vaasa, Finland
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12
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Chen KL, Chen CH. [The medical autonomy of elderly in Taiwan]. Hu Li Za Zhi 2014; 61:26-32. [PMID: 25271030 DOI: 10.6224/jn.61.5.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The elderly population is increasing rapidly in Taiwan. With the average life expectancy on the rise, the elderly have become major consumers of healthcare products and services. Factors that influence respect for autonomy, a core value of medical ethics, may be related to family, society, and the medical culture. Especially in patients who are already elderly, aging causes declines in physical, mental and societal capacities. Practicing a respect for patient autonomy is particularly challenging for healthcare professionals in Taiwan due the unique culture background of elderly Taiwanese patients. This article reviews and integrates the literature related to the issue of patient autonomy and elaborates on medical decision-making among elderly patients in Taiwan in the contexts of: the disadvantages faced by the elderly, the background of Chinese culture, and the current medical decision-making environment. A few suggestions are proposed to help preserve the medical-decision-making autonomy of elderly patients in Taiwan.
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Affiliation(s)
- Kai-Li Chen
- Department of Nursing, Tajen University, Taiwan, ROC
| | - Ching-Huey Chen
- Department of Nursing, Institute of Allied Health Sciences, Taiwan, ROC.
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Ray-Coquard I, Montesco MC, Coindre JM, Dei Tos AP, Lurkin A, Ranchère-Vince D, Vecchiato A, Decouvelaere AV, Mathoulin-Pélissier S, Albert S, Cousin P, Cellier D, Toffolatti L, Rossi CR, Blay JY. Sarcoma: concordance between initial diagnosis and centralized expert review in a population-based study within three European regions. Ann Oncol 2012; 23:2442-2449. [PMID: 22331640 PMCID: PMC3425368 DOI: 10.1093/annonc/mdr610] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/07/2011] [Accepted: 12/07/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sarcomas represent a heterogeneous group of tumors. Accurate determination of histological diagnosis and prognostic factors is critical for the delineation of treatment strategies. The contribution of second opinion (SO) to improve diagnostic accuracy has been suggested for sarcoma but has never been established in population-based studies. METHODS Histological data of patients diagnosed with sarcoma in Rhone-Alpes (France), Veneto (Italy) and Aquitaine (France) over a 2-year period were collected. Initial diagnoses were systematically compared with SO from regional and national experts. RESULTS Of 2016 selected patients, 1463 (73%) matched the inclusion criteria and were analyzed. Full concordance between primary diagnosis and SO (the first pathologist and the expert reached identical conclusions) was observed in 824 (56%) cases, partial concordance (identical diagnosis of connective tumor but different grade or histological subtype) in 518 (35%) cases and complete discordance (benign versus malignant, different histological type or invalidation of the diagnosis of sarcoma) in 121 (8%) cases. The major discrepancies were related to histological grade (n = 274, 43%), histological type (n = 144, 24%), subtype (n = 18, 3%) and grade plus subtype or grade plus histological type (n = 178, 29%). CONCLUSION More than 40% of first histological diagnoses were modified at second reading, possibly resulting in different treatment decisions.
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Affiliation(s)
- I Ray-Coquard
- University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France.
| | - M C Montesco
- Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | - J M Coindre
- University Bordeaux Segalen; INSERM U916, Bordeaux, France
| | | | - A Lurkin
- University Lyon, EAM 4129 Health Individual Society, Hôtel Dieu, Lyon; Centre Léon Bérard, Lyon, France
| | | | - A Vecchiato
- Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy
| | | | - S Mathoulin-Pélissier
- University Bordeaux Segalen; INSERM U916, Bordeaux, France; INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux
| | - S Albert
- INSERM CIC-EC7 and Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux
| | - P Cousin
- Centre Léon Bérard, Lyon, France
| | | | | | - C R Rossi
- Veneto Institute of Oncology (IOV), IRCCS, Padova, Italy; University of Padova, Italy
| | - J Y Blay
- Centre Léon Bérard, Lyon, France; NSERM U590 Cytokine and Cancer, Centre Léon Bérard, Lyon, France
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